A study on the decontamination of insoles colonized by Trichophyton rubrum: effect of terbinafine spray powder 1% and terbinafine spray solution 1%.

Background  Shoes worn with bare feet function as a fungal reservoir and lead to persistent dermatophytosis. Objective  This study was designed to evaluate two formulations of terbinafine (1% spray powder or solution) to treat the insoles of shoes colonized by skin scales infected with Trichophyton rubrum and to determine the contact time necessary to achieve decontamination. Methods  Infected skin scales weighing 0.5 g, taken from the feet of patients with confirmed T. rubrum infection, was dispersed onto insoles pre-moistened with sterile saline solution (to mimic perspiration). Three types of insole were tested (felt, latex, leather). After inoculation, insoles were placed separately in new cardboard boxes at ambient temperature, and re-humidified with sterile normal saline solution for 48 h before being treated; untreated insoles served as controls. Scales were scraped off at 48 h or 96 h, and dropped into tubes of Sabouraud agar, incubated at 27°C and examined at 3 and 6 weeks. Results  Cultures from all control insoles showed numerous T. rubrum colonies. In contrast, cultures from all insoles treated with a single application of terbinafine 1% spray solution or powder, and taken after 48 h or 96 h contact with the product, remained sterile at 3 weeks and 6 weeks. Conclusion  This study demonstrated the successful treatment of insoles colonized by T. rubrum-infected skin scales. Terbinafine 1% spray solution and powder showed good efficacy; the dermatophyte could no longer be cultured 48 h after a single application of terbinafine.